Institute of Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY.
Department of Vascular Surgery, University of Thessaly, Larissa, Greece.
Blood. 2021 May 20;137(20):2838-2847. doi: 10.1182/blood.2020010529.
Thromboembolic events, including venous thromboembolism (VTE) and arterial thromboembolism (ATE), and mortality from subclinical thrombotic events occur frequently in coronavirus disease 2019 (COVID-19) inpatients. Whether the risk extends postdischarge has been controversial. Our prospective registry included consecutive patients with COVID-19 hospitalized within our multihospital system from 1 March to 31 May 2020. We captured demographics, comorbidities, laboratory parameters, medications, postdischarge thromboprophylaxis, and 90-day outcomes. Data from electronic health records, health informatics exchange, radiology database, and telephonic follow-up were merged. Primary outcome was a composite of adjudicated VTE, ATE, and all-cause mortality (ACM). Principal safety outcome was major bleeding (MB). Among 4906 patients (53.7% male), mean age was 61.7 years. Comorbidities included hypertension (38.6%), diabetes (25.1%), obesity (18.9%), and cancer history (13.1%). Postdischarge thromboprophylaxis was prescribed in 13.2%. VTE rate was 1.55%; ATE, 1.71%; ΑCM, 4.83%; and MB, 1.73%. Composite primary outcome rate was 7.13% and significantly associated with advanced age (odds ratio [OR], 3.66; 95% CI, 2.84-4.71), prior VTE (OR, 2.99; 95% CI, 2.00-4.47), intensive care unit (ICU) stay (OR, 2.22; 95% CI, 1.78-2.93), chronic kidney disease (CKD; OR, 2.10; 95% CI, 1.47-3.0), peripheral arterial disease (OR, 2.04; 95% CI, 1.10-3.80), carotid occlusive disease (OR, 2.02; 95% CI, 1.30-3.14), IMPROVE-DD VTE score ≥4 (OR, 1.51; 95% CI, 1.06-2.14), and coronary artery disease (OR, 1.50; 95% CI, 1.04-2.17). Postdischarge anticoagulation was significantly associated with reduction in primary outcome (OR, 0.54; 95% CI, 0.47-0.81). Postdischarge VTE, ATE, and ACM occurred frequently after COVID-19 hospitalization. Advanced age, cardiovascular risk factors, CKD, IMPROVE-DD VTE score ≥4, and ICU stay increased risk. Postdischarge anticoagulation reduced risk by 46%.
血栓栓塞事件，包括静脉血栓栓塞症（VTE）和动脉血栓栓塞症（ATE），以及亚临床血栓事件导致的死亡率，在 2019 年冠状病毒病（COVID-19）住院患者中经常发生。这种风险是否会在出院后持续存在一直存在争议。我们的前瞻性登记包括了在我们的多医院系统中，于 2020 年 3 月 1 日至 5 月 31 日期间住院的 COVID-19 连续患者。我们记录了人口统计学特征、合并症、实验室参数、药物治疗、出院后血栓预防以及 90 天的结局。电子健康记录、健康信息交换、放射学数据库和电话随访的数据被合并。主要结局是经过裁决的 VTE、ATE 和全因死亡率（ACM）的复合结局。主要安全性结局是大出血（MB）。在 4906 名患者（38.6%为男性）中，平均年龄为 61.7 岁。合并症包括高血压（38.6%）、糖尿病（25.1%）、肥胖（18.9%）和癌症病史（13.1%）。出院后预防性抗凝治疗的处方率为 13.2%。VTE 发生率为 1.55%；ATE 为 1.71%；ACM 为 4.83%；MB 为 1.73%。复合主要结局发生率为 7.13%，且与高龄（比值比 [OR]，3.66；95%置信区间 [CI]，2.84-4.71）、既往 VTE（OR，2.99；95% CI，2.00-4.47）、重症监护病房（ICU）住院（OR，2.22；95% CI，1.78-2.93）、慢性肾脏病（CKD；OR，2.10；95% CI，1.47-3.0）、外周动脉疾病（OR，2.04；95% CI，1.10-3.80）、颈动脉闭塞性疾病（OR，2.02；95% CI，1.30-3.14）、IMPROVE-DD VTE 评分≥4（OR，1.51；95% CI，1.06-2.14）和冠状动脉疾病（OR，1.50；95% CI，1.04-2.17）有关。出院后抗凝治疗与主要结局的降低显著相关（OR，0.54；95% CI，0.47-0.81）。COVID-19 住院后，经常发生出院后 VTE、ATE 和 ACM。高龄、心血管危险因素、CKD、IMPROVE-DD VTE 评分≥4 和 ICU 住院增加了风险。出院后抗凝治疗可降低 46%的风险。
